IVF and Related Treatments

The following Assisted Reproductive Technology (ART) procedures are somtimes combined with IVF:

PRE-IMPLANTATION GENETIC DIAGNOSIS (PGD)

This technique provides a way for couples who are carriers of a genetic disease – such as cystic fibrosis, Tay-Sachs or sickle cell anemia, to name just a few – to avoid having a child with the disease. During IVF, each embryo is analyzed in a genetics lab to see which embryos are free of the genetic abnormality in question. By putting back only the embryos that are free of the genetic defect, the risk of the child having the condition is dramatically reduced. PGD can also be used for family balancing (for couples looking to have a baby of a particular gender).

PRE-IMPLANTATION GENETIC SCREENING (PGS)

This term is used when both parents are known or presumed to be genetically normal, but they still want to reduce the chance of having a chromosomally abnormal child. The embryos are tested for having too many or too few chromosomes (a condition called aneuploidy), and only the normal embryos are replaced in the uterus.

ASSISTED HATCHING

The assisted hatching procedure involves thinning or making a small hole in the protective layer (zona pellucid) that surrounds the embryo just before the embryos are transferred to the uterus. This technique may increase the likelihood of implantation of the embryo and pregnancy.

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

Intra-cytoplasmic sperm injection (ICSI) is a procedure that is used primarily in cases of male factor infertility. The embryologist will inject a single sperm into the cytoplasm of each egg using a fine glass needle. The sperm and egg are kept in an incubator, then examined by the embryologist the next day to see if the egg fertilized. ICSI greatly increases the chances that a compromised sperm will fertilize an egg. ICSI was first performed in 1992 but is now a well-established procedure.

FERTILITY PRESERVATION

This refers to retrieving eggs and freezing them, or fertilizing them with sperm and freezing the resulting embryos (rather than transferring them to the uterus) in an effort to preserve a woman's fertility for the future. At any point in the future, the eggs or embryos can be thawed and transferred back to the woman's uterus. This is a good option if you are older and want to store some eggs for the future, or if you will soon undergo chemo and want to freeze your eggs before chemo renders them unusable.

DONOR EGG IVF

If a successful pregnancy is unlikely due to age or a decrease in ovarian function, using eggs from a donor may be a viable option.

BLASTOCYST TRANSFER

Instead of the traditional procedure of transferring embryos to the uterus two or three days after IVF, blastocyst culture and transfer allows the embryos to grow for five or six days to the blastocyst stage of development. Thanks to this additional development time, we are able to more accurately determine the best embryos for implantation. This procedure increases per embryo implantation rates and reduces the risk of multiple births since we can be more selective in choosing the embryos we transfer back to the mother.

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is an advanced fertility treatment with excellent success rates. However, it can be time-consuming and expensive. For these reasons, IVF is not usually recommended as a first course of treatment, but for situations where simpler methods have been unsuccessful.

What is IVF?

In vitro fertilization (IVF) is a process in which eggs are harvested from the woman's ovaries, then mixed with sperm in a lab and allowed to fertilize. The fertilized eggs are kept in culture in an incubator, then transferred to the woman's uterus as embryos.

The treatment has come a long way since the first IVF baby was born in 1978. Today, more than 3 million IVF babies later, it is a well-accepted procedure. Thanks to medical advances, incidences of high-multiple births (greater than twins) are now very low.

Overview of the IVF Process

1. Ovarian stimulation with gonadotropins (Bravelle®, Menopur®, Repronex®,

Follistim®,Gonal -F®) After fully explaining the procedures, risks and benefits involved, we'll get you started with injectable medication to stimulate the ovaries to release mature eggs.

2. Monitoring your progress. Once you are in your cycle, you'll come to our office

approximately four to six times over a 10 to 14 day period - for ultrasounds to measure the growth of the eggs contained in the follicles, and blood tests to monitor your estrogen levels.

3. Retrieving and inseminating your eggs. After approximately 10 days of injections,

you will take an injection of hCG (Profasi®, Pregnyl®, Novarel®, or Ovidrel®) to allow the eggs to more fully mature and be retrieved from the ovaries. Approximately 36 hours after this hCG injection, we'll extract the eggs from your ovaries in the embryology facility, using a needle that is placed through the vagina into the follicles under ultrasound guidance. You will be asleep for this approximately 15-minute procedure. An embryologist will then inseminate the eggs with sperm, sometimes using a technique known as ICSI (intracytoplasmic sperm injection). After the sperm and eggs have been in the incubator for one day, the embryologist can determine which eggs are fertilized.

4. Implanting the eggs. After 2-5 days in the incubator, the embryos can be

transferred back into uterus in a painless procedure using a small catheter. After the embryo transfer, you will take supplemental progesterone and estrogen treatments to help the embryos implant in the uterine lining.

5. Determining if the embryo(s) implanted. Two weeks after the egg retrieval

you will have a blood test in our office to see if you are pregnant. If you are, we will monitor the pregnancy for another 3-5 weeks to ensure the embryos are growing normally and in the proper place. For a more in-depth overview of the process, see SART's step-by-step guide to ART.

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